MECTA - THIRTY-FIVE YEARS OF NEUROMODULATION INNOVATIONS

OpTIMIzED and FULL SpECTRUM DOSINg parameter Sets

NEW STANDARD OF CARE NEW DOSINg pARAMETER SETS OFFERINg gREATER EFFICIENCIES AND WIDER TREATMENT RANgES
Pulse width, pulse frequency, train duration, and current (pulse amplitude) are the ECT stimulus parameters that radically determine the efficiency of stimulation.1,2 Now MECTAs newest, more efficient and flexible treatment options allow clinicians and ECT researchers a more extensive and optimized range of treatment parameters. Heres how: OpTIMIzED DOSINg parameter Sets 0.3, 0.5, 1.0 ms NEW! Evidence for Optimization
pULSE WIDTH likely has the greatest impact on the efficiency of stimulation. For example, the overall dosage (i.e., the charge) needed to elicit seizures is approximately 3-4 times lower when a 0.3 ms pulse width is used than when a 1.5 ms pulse width is used. Thus, selecting a pulse width is a key clinical determination, and MECTA spECTrum device users now have the option to choose from three pre-selected ranges of optimized pulse widths that begin with 0.3 ms ultrabrief stimulation, or 0.5 ms or 1.0 ms brief pulse stimulation. These pulse widths correspond to the administration of an ultrabrief stimulus (0.3 ms), a stimulus (0.5 ms) on the border between ultrabrief pulse (0.3-0.49 ms), and brief pulse (0.5-2.0 ms) stimulation which is now limited to a maximally wide brief pulse (1.0 ms). Since the inefficiency of wider pulses is firmly established, the upper-limit for all spECTrum devices is now 1.0 ms.
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DURATION There is evidence that increasing the duration of the pulse train is more efficient than increasing pulse frequency. Overall, the evidence suggests that increases in train duration may be the next most critical parameter in terms of impact on the efficiency of seizure elicitation. Consequently, on the single dial 5000M model, before any other parameter is altered, increases in dose first involve an increase in train duration, until the maximum of 8 seconds is reached. On the MECTA 5000Q/M models and in all OPTIMIZED and FULL SPECTRUM DOSING Parameter Sets, the range of train duration is now from less than 0.5 to 8 seconds.
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FREQUENCY In the 5000M, pulse frequency is the parameter that is changed after train duration to increase dosage. It is firmly established that increases in stimulus frequency contribute to seizure induction since stimulus dose titration has often been conducted with stimulus frequency as the primary variable manipulated when incrementing dosing. The maximum frequency in the ultrabrief 0.3 ms parameter set is 120 Hz. At longer pulse widths (0.5 ms and 1.0 ms), maximum device output (1152 mC international devices) is achieved at lower pulse frequencies, resulting in a pulse frequency cutoff specific to each parameter set.
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CURRENT Current or pulse amplitude is fixed at 800 mA in the OPTIMIZED 5000Q parameter sets and all of the 5000M parameter sets. There is little published information on optimal pulse amplitude in ECT. The vast body of clinical research with MECTA devices has exclusively used the 800 mA setting, although there has been speculation that titration in the current domain* may ultimately prove superior in refining stimulus properties. MECTA provides the only device with flexibility and choice of pulse amplitudes. Indeed, the 5000Q devices have an expanded range of pulse amplitudes in the new FULL SPECTRUM DOSING Parameter Sets. This range is from 500 mA to 900 mA. NEW!
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Please contact a MECTA representative in your area for information and upgrades.
D-CS #0053 Rev A 145253 PP 4/29/11 INT

MECTA - THIRTY-FIVE YEARS OF NEUROMODULATION INNOVATIONS

SPECTRUM ULTRABRIEF

Tables. These are the most accurate and up to date The spECTrum 5000Q model now includes a fourthULTRABRIEF ECT - ENSURING EFFICACY tables, OPTIMIZED DOSING WITH or taking into account gender, age, and electrode placement. parameter set that allows the experienced clinician NEW! Dosing is provided at EFFECTS WHILE MARKEDLY pulse researcher to vary pulse width, train duration, REDUCING COGNITIVE SIDE 1.5, 2.0, 2.5 and 6x seizure threshold, and isms pulse width and 2.5at 0.3,seizure These landmark Ultrabrief ECT parameters were introduced bilateral ECT (1.5 separately provided times 0.5 and frequency and current independently throughout the in 1.0 pulse widths.unilateral ultrabrief ECT is a clear advance the range of device parameters. Only with the spECTrum threshold).3 Right Empirical titration remains the most full Fall of 2003 by MECTA and have had a major impact on the 1,2 accurate way to determine seizure threshold. with little for the field as patients show rapid improvement MECTA field. Controlled research at Columbia University has shown 5000Q FULL SPECTRUM DOSING Parameter Sets can provides extensive new and ECTRUMs offer the only that the 0.3 msec ultrabrief pulse width sharply reduces sign of cognitive deficit. The SP Historical Titration and individualized and historical doses be selected and set, ultrabrief parameter Tables for the OPTIMIZED and seizure threshold, allowing treatments to be given at much Pre-Selected Dosingset that allows for ultrabrief pulse FULL using the knobdosage thaninterface without accessing stimulation DOSING Parameter Sets. NEW! lower electrical and visual had been previously possible. SPECTRUMacross nearly the full output range of the device. menus. This enhances the efficiency of operation and Most critically, when compared to standard brief pulse NEW STANDARD representative in your area for pricing Contact a MECTAOF CARE allows the clinician and theparameters results in a profound stimulation, use of ultrabrief researcher the greatest In the new OPTIMIZED DOSING and upgrade information andParameter SetsPre-Selected also to order the 0.3 is freedom in their choice of parameters. domains, this reduction in cognitive side effects. In many used with a fixed current at 800 mA NEW! and in the FULL and Titration Dosing Tables and/or a 0.3 can be utilized advantage for AND pRE-SELECTED large or larger than SPECTRUM DOSING Parameter Sets, the new MECTA TITRATIONultrabrief stimulation is asDOSINg TABLES Instruction Manual containing the to 900 mA, as for usingin the difference between bilateral and right unilateral ECT in with a range of current from 500 mA instructions titration With cognitive effects. Definitive research published MECTA these changes in optimized parameter sets, in 2008 these new stimulus dosing parameters.superior in refining their the current domain may ultimately prove
confirms that right unilateral ECT given at 6 times initial stimulus properties.2,4 * NEW! All four SPECTRUM units can seizure HA, Long J, Luber B, a 0.3 ms pulse width is DP, Nobler MS. Physical properties and quantification of the ECT stimulus:form of stimulation as Therapy. be upgraded to include this new I. Basic principles. Convulsive a 1. Sackeim threshold withMoeller J, Prohovnik I, Devanandequivalent in 1994;10:93-123. efficacy to the therapeutic effects using a robust form of menu selection. 2. Peterchev AV, Rosa M, Deng Z, Prudic J, Lisanby S. Electroconvulsive therapy stimulus parameters: rethinking dosage. Journal of ECT. 2010;3:159-174.

has OF CARE FULL SpECTRUM DOSINg parameter Sets NEW! NEW STANDARD developed new Titration and Pre-Selected Dosing

1. Lisanby, S.H., Sackeim, H.A.(2001). New developments in Payne N, Berman RM, Brakemeier EL, Perera TP, Devanand DP. Effects of pulse width and electrode placement on the 3. Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH,convulsive therapy. Epilepsy & Behavior 2:S68-73. 2. efficacy and cognitiveThe convulsant and anticonvulsant properties of electroconvulsive therapy: towards a focal form of brain stimulation. Clinical Neuroscience Research. 4:39-57. Sackeim, H.A. (2004). effects of electroconvulsive therapy. Brain Stimulation. 2008;1:71-83. 3. Sackeim, DP, Lisanby SH, Effects of Sackeim HA. The relative placement altering pulse and cognitive effects of electroconvulsive therapy. Brain Stimulation. 1:71-83. 4. DevanandH.A.,et al.(2008).Nobler MS,pulse width and electrodeefficiency ofon the efficacy frequency or train duration when determining seizure threshold. The Journal of ECT. 4.1998;4:227-235.Rosa, M., Deng, Z., Prudic, J., Lisanby, S. (2010). Electroconvulsive therapy stimulus parameters: Rethinking dosage. Journal of ECT. 3:159-174. Peterchev, A.V., 5. Sackeim, H.A. (2004). Electroconvulsive S. Seizure threshold in ECT: effects of sex, C. (Ed.), Clinical Geriatric Psychopharmacology. 4:385-422. 5. Sackeim HA, Decina P, Prohovnik I, Malitztherapy in late life depression. In Salzman,age, electrode placement and number of treatments. Archives of General Psychiatry. 1987;44:355-360. 6. Sackeim HA, Prudic J, Devanand DP, Kiersky JE, Fitzsimons L, Moody BJ, McElhiney MC, Coleman EA, Settembrino JM. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine. 1993;328:839-846. 7. Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Fitzsimons L, Moody BJ, Clark J. A prospective, randomized, double-blind comparison of bilateral and right 5 unilateral ECT at different stimulus intensities. Archives of General Psychiatry. 2000;57:425-437. 8. Sackeim HA. The convulsant and anticonvulsant properties of electroconvulsive therapy: towards a focal form of brain stimulation. Clinical Neuroscience Research. 2004;4:39-57. 9. Sackeim HA. Electroconvulsive therapy in late life depression. In Salzman, C. (Ed.), Clinical Geriatric Psychopharmacology. 2004;4:385-422.

Contact MECTA representative in your area for pricing and upgrade information and also to order the most accurate and up to date Titration and Pre-Selected Dosing Tables, taking into account gender, age, and electrode placement (up to sixteen tables) . NEW! Order a new MECTA Instruction Manual containing the instructions for using these new OPTIMIZED and FULL SPECTRUM DOSING Parameter Sets. ECT PARAMETERS // 200 JOULESYSTEMS ECT pARAMETERS 200 JOULES SYSTEMS
Q Models
OPTIMIZED DOSING Parameter Sets

FULL SPECTRUM DOSING Parameter Set

Four Parameter Sets: Pulse Width Stimulus Duration Frequency Stimulus Current Charge Energy @ 220 ohm patient impedance M Models Three Parameter Sets: Pulse Width Stimulus Duration Frequency Stimulus Current Charge Energy @ 220 ohm patient impedance
* Patent Pending *Patent Pending

0.3 0.3-0.75 ms 0.5-8.0 sec 20-120 Hz 800 mA 4.0-1152 mC 0.8-202.8 joules

0.5 0.5-0.75 ms 0.5-8.0 sec 20-120 Hz 800 mA 8.0-1152 mC 1.4-202.8 joules

1.0** 1.0 ms 0.5-8.0 sec 20-90 Hz 800 mA 16-1152 mC 2.8-202.8 joules

Set 4** NEW! 0.3-1.0 ms 0.5-8.0 sec NEW! 20-120 Hz 500-900 mA NEW! 3.0-1152 mC 0.3-202.8 joules

OPTIMIZED DOSING Parameter Sets

0.3 0.30.75 ms 1.19-8.0 sec 20-120 Hz 800 mA 11-1152 mC 2.0-202.8 joules

0.5 0.5-0.75 ms 0.71-8.0 sec 20-120 Hz 800 mA 11-1152 mC 2.0-202.8 joules

1.0** 1.0 ms 0.35-8.0 sec 20-90 Hz 800 mA 11-1152 mC 2.0-202.8 joules

NEW! NEW! NEW!

**EEG Data Analysis enabled for use with 1.0 OPTIMIZED DOSING Parameter Sets Historical Parameters in the FULL SPECTRUM DOSING Parameter Set. **EEG Data Analysis enabled for use with 1.0 OPTIMIZED DOSING Parameter Sets andand historical parameters in FULL SPECTRUM DOSING Parameter Set.

MECTA EVIDENCE

Visit our website at www.mectacorp.com

Please contact a MECTA representative in your area for information and upgrades. Please contact MECTA representative in your area for information and upgrades.
D-CS #0053 Rev AD-CS-#0028 Rev C 4/29/11 145253 PP 4/29/11 INT

BASED ECT TECHNOLOGY